A worksheet for you, before we begin

Getting ready together

There's no rush and nothing here is required. Fill in as much or as little as feels okay — even a few words is a helpful starting point for a conversation. You'll bring this with you, and we'll go through it at your pace.

Part 1 of 4

A little about you

Just so this worksheet is yours — your therapist will already know some of this, so skip anything that feels redundant.

Your name (optional)

Today's date

What brings you here, in your own words?

Part 2 of 4

Looking back

Are there memories — big or small, recent or old — that feel connected to what you're working on? List whichever come to mind first; you don't have to search for the "worst" one, and you can always add more later.

Memory 1

Roughly when (age, year, or a rough sense of timing)

What happened — share as much or as little as feels okay

What it made you believe about yourself (pick one, or write your own)

What you'd rather believe about yourself now (optional)

You're in control. A rough sense of "when" (an age, a year, "sometime in my twenties") is plenty — no need for exact dates or full detail unless you want to include it.

Part 3 of 4

What brings it up now

What situations, people, or moments in everyday life seem to stir up this same feeling today?

Situation 1

What's the situation, or who/what is involved?

What do you notice — in your body, thoughts, or mood?

Part 4 of 4

Looking ahead

Is there a situation coming up — or one you tend to avoid — where you'd like to feel more like yourself? Describe how you'd like to be able to respond.

Situation 1

A future situation you'd like to feel differently in

How would you like to feel or respond instead?

This worksheet stays in your browser only — nothing is sent anywhere. Save a copy or print it to bring along, and clear it whenever you like.

If anything here feels like a lot to sit with, that's worth mentioning to your therapist, or a trusted person, before you move on.

Your answers save automatically on this device